Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HETA 2001-0445-3141, 2011 Sep; :1-64
In July 2001, NIOSH received a health hazard evaluation request from a local union representing employees at a state office building in Connecticut. There had been reports of asthma, hypersensitivity pneumonitis, and sarcoidosis occurring among occupants in the building. The building, which had a reported history of water incursion and damage, was originally built in 1985 and purchased by the state of Connecticut from a private company in 1994. Two agencies had been in the office building since the building was purchased, with Agency A occupying the 5th, 6th, and upper floors (14th-20th) and Agency B on the lower floors (7th-12th floors). In 2005, another state agency, Agency C, relocated to the 6th floor of the building. The first four floors are used for parking. NIOSH conducted an initial health survey in 2001 and medical and environmental surveys in 2002. After these surveys, the building underwent major remediation between 2002 and early 2004, with additional remediation through 2007. After major remediation was completed, NIOSH conducted the first follow-up health questionnaire survey in 2004 and two additional follow-up surveys in 2005 and 2007. NIOSH also performed follow-up medical surveys in 2004 and 2005 on a subset of employees, and conducted follow-up environmental evaluations in 2004, 2005, and 2007. NIOSH invited all occupants to participate in the health questionnaire surveys offered in 2001, 2004, 2005, and 2007. Results of the 2001 health questionnaire survey indicated elevated prevalences of asthma and lower respiratory symptoms in the building compared to national and state data. There was a 7.5 times increased incidence of adult-onset asthma after building occupancy compared to before occupancy. Some occupants reported new-onset sarcoidosis and hypersensitivity pneumonitis. From the initial 2001 health and 2002 environmental surveys, NIOSH found that occupants with relatively higher exposure to fungi or endotoxin (a cell wall component of Gram-negative bacteria) in the building had a greater risk of respiratory symptoms and post-occupancy physician-diagnosed asthma in an exposure-dependent way, and that occupants with exposure to both higher mold and higher endotoxin levels in the building had an even greater risk of respiratory illnesses than the summation of the individual risks of higher mold and higher endotoxin concentrations. Throughout the follow-up surveys conducted after the major remediation was completed, NIOSH continued to find elevated rates of symptoms and disease in the building. Rates of lower respiratory symptoms and asthma remained elevated when compared to national and state data. However, the new onset of diseases such as asthma, hypersensitivity pneumonitis, and sarcoidosis appeared to decline after 2001 or 2002. Respiratory and non-respiratory complaints were higher among occupants who had worked in the building for longer time periods (hired prior to 2004), compared to occupants with shorter occupancy times (hired in 2004 or later). In general, we observed no overall improvement in respiratory health, as reflected in symptom scores, overall medication use, spirometry abnormalities, or sick leave when we compared 97 employees' paired medical data from 2002 and 2005. In addition, occupants who reported building-related nasal or sinus symptoms in the 2001 survey had a higher risk of developing building-related lower respiratory symptoms (wheeze, chest tightness, attacks of shortness of breath, cough, or awakened by an attack of breathing difficulty) in any one of the three follow-up surveys. In this repeated measurement analysis, data suggest that employees with rhinosinusitis symptoms that were not associated with building occupancy did not have an increased risk of building-related asthma symptoms. The levels of total culturable fungi in the building decreased in 2004 and 2005 compared to 2002 levels, but increased in 2007. This increase in 2007 occurred on all 15 occupied floors and was mostly attributable to an increase in hydrophilic fungi (fungal group requiring high moisture content to survive and grow on substrates). Repeated measurement analysis showed a significant effect of remediation in floor dust levels in 2004 and 2005 for total and hydrophilic fungi and for endotoxin in 2004, after major remediation was completed between 2002 and early 2004. However, this remediation effect disappeared in 2007, which suggests inadequate ongoing remediation. In summary, this office building with a long history of water incursion is associated with excess respiratory disease among employees. Extensive remediation of water damage temporarily lowered indices of microbial contamination but the building continued to have recurrent water incursion in 2007 and 2008 as documented in consultant reports. Although new employees occupying the building between 2004 through 2007 had fewer respiratory complaints, previously affected employees, on average, did not regain their respiratory health. Employees should seek medical guidance quickly if they develop symptoms. Ongoing medical surveillance can provide health data to guide management decisions about relocation of affected employees and risk management of continued building occupancy in relation to remediation and productivity costs.
Office-workers; Respiratory-system-disorders; Pulmonary-system-disorders; Microorganisms; Molds; Endotoxins; Bronchial-asthma; Indoor-air-pollution; Indoor-environmental-quality;
Author Keywords: Public Finance Activities; Other Justice, Public Order, and Safety Activities; Administration of Human Resource Programs; indoor air pollution; indoor air quality; mold; endotoxin; asthma; hypersensitivity pneumonitis; sarcoidosis; dampness; water damage